New-onset atrial fibrillation is associated with 28-day mortality among patients with sepsis

Background: New-onset atrial fibrillation (NO-AF) has been associated with adverse outcomes in sepsis. The definition of sepsis is based on organ dysfunction by use of the Sequential Organ Failure Assessment (SOFA) score. However, adult patients with suspected infection can be identified as being more likely to have poor outcomes typical of sepsis if they have at least two qSOFA criteria. We have analyzed the occurrence of NO-AF on admission and 28-day mortality among infected patients with two or more qSOFA criteria on admission. Methods: A prospective cohort study of infected patients aged 18 years or older admitted to the emergency department (ED) of Slagelse Hospital during 01.10.2017 – 31.03.2018 (171 days). The population in the area was 198.000. All patients with suspected or documented infection on arrival, and treated with antibiotics, were included. NO-AF was defined as episodes of atrial fibrillation (AF) within 4 hours from admission documented on a 12-lead electrocardiogram and without a history of prior AF. We used a logistic regression analysis to adjust for the potential confounding of the association between NO-AF and 28-day mortality. Survival status was obtained from the Danish Civil Registration System. Results: A total of 2.168 infected patients with median age of 73.1 years were included, and 181 (8.3%; 95% CI 4.7-13.3) fulfilled at least two qSOFA criteria on admission. The incidence of sepsis based on qSOFA criteria was estimated to 194/100,000. A total of 15 (8.3%, 95% CI 4.7-13.3) qSOFA patients developed NO-AF. The 28-day mortality among all qSOFA patients was 17.1% (95% CI 11.9-23.4), 40.0% (95 % 16.3-67.7) among patients with NO-AF and 15.1% (95% CI 10.0-21.4) among patients without NO-AF). Unadjusted odds ratio for 28-day mortality among NO-AF patients was 3.8 (95% CI 1.2-11.50) and 4.6 (95% CI 1.4-15.3) after adjustment for several potential confounders. Conclusion: New-onset atrial fibrillation is independently associated with 28-day mortality among patients with qSOFA defined sepsis.

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Risk factors for new-onset atrial fibrillation during critical illness: A Delphi study

Journal of the Intensive Care Society ◽

10.1177/17511437211022132 ◽

2021 ◽

pp. 175114372110221

Author(s):

Jonathan P Bedford ◽

Tessa Garside ◽

Julie L Darbyshire ◽

Timothy R Betts ◽

J Duncan Young ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Critical Illness ◽

Delphi Study ◽

Delphi Process ◽

Modifiable Risk Factors ◽

Plasma Electrolyte ◽

Poor Outcomes ◽

Onset Atrial Fibrillation ◽

New Onset

Background New-onset atrial fibrillation (NOAF) is common during critical illness and is associated with poor outcomes. Many risk factors for NOAF during critical illness have been identified, overlapping with risk factors for atrial fibrillation in patients in community settings. To develop interventions to prevent NOAF during critical illness, modifiable risk factors must be identified. These have not been studied in detail and it is not clear which variables warrant further study. Methods We undertook an international three-round Delphi process using an expert panel to identify important predictors of NOAF risk during critical illness. Results Of 22 experts invited, 12 agreed to participate. Participants were located in Europe, North America and South America and shared 110 publications on the subject of atrial fibrillation. All 12 completed the three Delphi rounds. Potentially modifiable risk factors identified include 15 intervention-related variables. Conclusions We present the results of the first Delphi process to identify important predictors of NOAF risk during critical illness. These results support further research into modifiable risk factors including optimal plasma electrolyte concentrations, rates of change of these electrolytes, fluid balance, choice of vasoactive medications and the use of preventative medications in high-risk patients. We also hope our findings will aid the development of predictive models for NOAF.

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MO397THE IMPACT OF NEW-ONSET ATRIAL FIBRILLATION ON ADVERSE OUTCOMES IN PATIENTS WITH SEPSIS-INDUCED ACUTE KIDNEY INJURY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0051 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Zorica Dimitrijevic ◽

Branka Mitic ◽

Sonja Salinger ◽

Goran Paunovic ◽

Stevan Glogovac ◽

...

Keyword(s):

Atrial Fibrillation ◽

Acute Kidney Injury ◽

Univariate Analysis ◽

Kidney Injury ◽

Adverse Outcomes ◽

Intermittent Hemodialysis ◽

Replacement Treatment ◽

Number Of Patients ◽

Onset Atrial Fibrillation ◽

New Onset

Abstract Background and Aims The mortality of septic patients with acute kidney injury (s-AKI) prevails high. Atrial fibrillation is commonly observed in the setting of systemic inflammation or infection. The study aimed to assess the incidence and predictors of new-onset atrial fibrillation (NOAF) in this population and its impact on intrahospital mortality. Method We conducted a retrospective cohort study of 462 patients admitted to our unit for s-AKI between January 2016 and December 2020. NOAF was defined as AF discovered during hospitalization in patients with sinus rhythm on admission. Subjects were classified into NOAF (n=68) and non-NOAF groups (n=364). There were no major differences in sepsis severity between groups, and all patients underwent intermittent hemodialysis as a renal replacement treatment modality. Results The NOAF incidence in the whole s-AKI population was 14.7%. In a univariate analysis, age (72.4 in patients with NOAF vs. 62.1 years in patients without NOAF, respectively; p=0.018), male gender (33.5 vs. 14.6%; p= 0.004), history of coronary disease (23.5 vs. 6.1%; p=0.07) and vasopressor medication use (19.0 vs. 8.2%; p = 0.002) were associated with NOAF. 116 (25.1%) patients died during the hospitalization, while 346 patients (74.9%) were discharged from the hospital. NOAF occurring in s-AKI was independently associated with an increased hazard of intrahospital death (HR: 1.36; 95% CI: 1.09–1.51), compared to the non-NOAF group. Conclusion A clinically significant number of patients hospitalized for s-AKI have NOAF, and it is associated with poor hospital outcomes.

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CHA2DS2VASc score and adverse outcomes in middle-aged individuals without atrial fibrillation

European Journal of Preventive Cardiology ◽

10.1177/2047487319868320 ◽

2019 ◽

Vol 26 (18) ◽

pp. 1987-1997 ◽

Cited By ~ 7

Author(s):

Giulia Renda ◽

Fabrizio Ricci ◽

Giuseppe Patti ◽

Nay Aung ◽

Steffen E Petersen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischaemic Stroke ◽

Cumulative Incidence ◽

Adverse Outcomes ◽

Annual Incidence ◽

Middle Aged ◽

Cox Regression Analysis ◽

Coronary Events ◽

Onset Atrial Fibrillation ◽

New Onset

Aims The CHA2DS2VASc score is used to evaluate the risk of thromboembolic events in patients with non-valvular atrial fibrillation. We assessed the prognostic yield of CHA2DS2VASc for new-onset atrial fibrillation, cardiovascular morbidity and mortality in a non-atrial fibrillation population. Methods We analysed a population-based cohort of 22,179 middle-aged individuals with ( n = 3542) and without ( n = 18,367) a history of atrial fibrillation; we grouped the population into five CHA2DS2VASc strata (0–1–2–3–≥4), and compared the risk of major adverse cerebro-cardiovascular events and mortality. Furthermore, we analysed the annual incidence of atrial fibrillation across different CHA2DS2VASc strata. Results Over a median follow-up of 15 years, 1572 patients (6.9%) had ischaemic strokes, 2162 (9.5%) coronary events and 5899 (26%) died. The cumulative incidence of ischaemic stroke in CHA2DS2VASc ≥ 4 subjects without atrial fibrillation was similar to patients with atrial fibrillation and CHA2DS2VASc 2, with a 10-year crude incidence rate of 0.91 (95% confidence interval (CI) 0.68–1.19) and 1.13 (95% CI 0.93–1.36) ischaemic strokes per 100 patient-years, respectively. CHA2DS2VASc in a non-atrial fibrillation population showed higher predictive accuracy for ischaemic stroke compared with an atrial fibrillation population (area under the curve 0.60 vs. 0.56; P = 0.001). In multivariable Cox regression analysis, CHA2DS2VASc ≥ 2 was an independent predictor of all-cause death (adjusted hazard ratio (aHR) 2.58; 95% CI 2.42–2.76), cardiovascular death (aHR 3.40; 95% CI 2.98–3.89), ischaemic stroke (aHR 2.20; 95% CI 1.92–2.53) and coronary events (aHR 1.83; 95% CI 1.63–2.04). The cumulative incidence of atrial fibrillation was greater with increasing CHA2DS2VASc strata, with an absolute annual incidence of more than 2% per year if CHA2DS2VASc ≥ 4. Conclusion The CHA2DS2VASc score is a sensitive tool for predicting new-onset atrial fibrillation and adverse outcomes in subjects both with and without atrial fibrillation.

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Cardiac Arrhythmias in a Septic ICU Population: A Review

The Journal of Critical Care Medicine ◽

10.1515/jccm-2015-0027 ◽

2015 ◽

Vol 1 (4) ◽

pp. 140-146 ◽

Cited By ~ 5

Author(s):

Andrei Schwartz ◽

Evgeni Brotfain ◽

Leonid Koyfman ◽

Moti Klein

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Critical Illness ◽

Critically Ill ◽

Cardiac Arrhythmias ◽

Mortality Rates ◽

Multiple Organ ◽

Poor Outcomes ◽

Onset Atrial Fibrillation ◽

New Onset

Abstract Progressive cardiovascular deterioration plays a central role in the pathogenesis of multiple organ failure (MOF) caused by sepsis. Evidence of various cardiac arrhythmias in septic patients has been reported in many published studies. In the critically ill septic patients, compared to non-septic patients, new onset atrial fibrillation episodes are associated with high mortality rates and poor outcomes, amongst others being new episodes of stroke, heart failure and long vasopressor usage. The potential mechanisms of the development of new cardiac arrhythmias in sepsis are complex and poorly understood. Cardiac arrhythmias in critically ill septic patients are most likely to be an indicator of the severity of pre-existing critical illness.

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